Abigail Quintos1, Mario Naranjo1, Colleen Kelly2, Stuart F Quan3, Sunil Sharma4. 1. Department of Internal Medicine and the Division of Pulmonary, Allergy and Sleep Medicine, Albert Einstein Medical Center, Sidney Kimmel Medical College, Philadelphia, PA, USA. 2. Kelly Statistical Consulting, San Diego, CA, USA. 3. Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Asthma and Airways Research Center, University of Arizona College of Medicine, Tucson, AZ, USA. 4. Department of Internal Medicine and the Division of Pulmonary, Allergy and Sleep Medicine, Albert Einstein Medical Center, Sidney Kimmel Medical College, Philadelphia, PA, USA. Electronic address: sharmasu@einstein.edu.
Abstract
PURPOSE: The HoSMed Database recently demonstrated a high prevalence of obstructive sleep apnea (OSA) in hospitalized obese patients. Based on a long-term follow-up, this study showed an improved survival among patients who were adherent with the therapy. In this post-hoc analysis we explore the characteristics, associations, and mortality outcome of OSA in the African American (AA) population. METHODS: These subset analyses included obese AA patients screened in the hospital as high-risk for OSA. Stepwise logistic regression analysis was used to identify predictors of OSA. Patients who had polysomnography (PSG) and were initiated on positive airway pressure (PAP) therapy were followed and dichotomized to adherent versus non-adherent groups based on compliance data. Mortality rates in both groups were compared. RESULTS: Of the total of 2022 AA patients screened, 1370 (60.7% females) were identified as high risk for OSA. Of these, 279 had PSG diagnosed OSA (mean AHI = 36/hour) and were initiated on PAP therapy. Adherence in AAs was significantly lower than for Caucasians (21% versus 45%, Chi-square p < 0.0001). The following statistically significant predictors of OSA were found: heart failure, chronic kidney disease, hypertension and asthma/COPD, BMI and age. A Log-rank survival analysis of AAs on CPAP showed non-significant benefit of adherence (HR: 0.22; 95% CI 0.03-1.7, p = 0.11); a propensity analysis of AAs and Caucasians that adjusted for race and potential confounding variables found a statistically significant benefit of adherence (HR: 0.29; 0.13-0.64; p = 0.002). CONCLUSION: This large database of hospitalized patients confirms a high prevalence and lower adherence to PAP therapy in African Americans. Adherent patients, however, showed mortality benefit similar to Caucasians.
PURPOSE: The HoSMed Database recently demonstrated a high prevalence of obstructive sleep apnea (OSA) in hospitalized obesepatients. Based on a long-term follow-up, this study showed an improved survival among patients who were adherent with the therapy. In this post-hoc analysis we explore the characteristics, associations, and mortality outcome of OSA in the African American (AA) population. METHODS: These subset analyses included obese AA patients screened in the hospital as high-risk for OSA. Stepwise logistic regression analysis was used to identify predictors of OSA. Patients who had polysomnography (PSG) and were initiated on positive airway pressure (PAP) therapy were followed and dichotomized to adherent versus non-adherent groups based on compliance data. Mortality rates in both groups were compared. RESULTS: Of the total of 2022 AA patients screened, 1370 (60.7% females) were identified as high risk for OSA. Of these, 279 had PSG diagnosed OSA (mean AHI = 36/hour) and were initiated on PAP therapy. Adherence in AAs was significantly lower than for Caucasians (21% versus 45%, Chi-square p < 0.0001). The following statistically significant predictors of OSA were found: heart failure, chronic kidney disease, hypertension and asthma/COPD, BMI and age. A Log-rank survival analysis of AAs on CPAP showed non-significant benefit of adherence (HR: 0.22; 95% CI 0.03-1.7, p = 0.11); a propensity analysis of AAs and Caucasians that adjusted for race and potential confounding variables found a statistically significant benefit of adherence (HR: 0.29; 0.13-0.64; p = 0.002). CONCLUSION: This large database of hospitalized patients confirms a high prevalence and lower adherence to PAP therapy in African Americans. Adherent patients, however, showed mortality benefit similar to Caucasians.
Authors: Martha E Billings; Robyn T Cohen; Carol M Baldwin; Dayna A Johnson; Brian N Palen; Sairam Parthasarathy; Sanjay R Patel; Maureen Russell; Ignacio E Tapia; Ariel A Williamson; Sunil Sharma Journal: Chest Date: 2020-09-30 Impact factor: 10.262